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Objective: Invasive procedures such as craniotomies, external ventricular drainage catheters, and penetrating head traumas increase the risk of nosocomial meningitis in neurosurgical intensive care unit patients. While some studies suggest that corticosteroids increase this risk, others argue no such effect present. The aim of this retrospective descriptive study was to reveal the effect of corticosteroid use in patients with nosocomial meningitis in the neurosurgical intensive care unit for five years on mortality, nosocomial infection, the number of surgical interventions and the duration of stay in intensive care unit. Materials and Methods: In this study, 13 cases that developed nosocomial meningitis from 2228 patients in the neurosurgical intensive care unit during a 5-year period were retrospectively analyzed. The effects of corticosteroid use on mortality, nosocomial infections, number of surgical interventions and length of stay in intensive care unit were investigated in patients with nosocomial meningitis. Results: The use of corticosteroid in patients with nosocomial meningitis had no effect on mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit (p>0.05). Conclusion: Corticosteroid use of neurosurgical intensive care unit patients with nosocomial meningitis does not affect mortality, nosocomial infection risk, number of surgical interventions and length of stay in intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: Almost half of intensive care patients are affected by acute kidney injury (AKI). The purpose of this study is to determine parameters that can be used for predicting of early (within 28 days) and late (within 90 days) mortality in patients who are followed-up with AKI in intensive care units. Materials and Methods: In this study, a dataset that contains 50 patients with AKI in intensive care units was used. This dataset contains blood urea nitrogen, creatinine, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase, alkaline phosphatase and gammaglutamyl transpeptidase values of patients who were admitted to intensive care for various reasons and who developed AKI on the days 1, 3 and 7. In addition to these values, laboratory results such as serum electrolytes on day 1, blood gas; vital signs such as mean arterial pressure, central venous pressure; and demographic data were also recorded. Data mining techniques were applied to determine correlation between all of these data and mortality. Results: The threshold level of urinary NGAL on day 7 was determined to be 69 ng/mL, and strong correlation was found between this threshold level and early mortality. Similarly, the threshold level of plasma NGAL on day 7 was determined to be 150 ng/mL, and this was highly correlated with early mortality. Besides, strong correlation was also found between the difference in the urinary NGAL levels on day 1 and 7, and early mortality. Conclusion: In this study, plasma and urinary NGAL levels were found to be closely related to early mortality in patients who were followed-up with AKI in intensive care units. On the other hand, any parameter associated with late mortality was not found. [ABSTRACT FROM AUTHOR]

Introduction: In patients hospitalized in the intensive care unit (ICU); muscle atrophy and neuromuscular weakness may develop due to infection, trauma, surgery, burn. In this case report, we aimed to share the diagnosis and treatment process of our patient. Case: A 71-year-old female patient was admitted to our ICU with the diagnosis of COVID-19. High flow oxygen therapy and non-invasive mechanical ventilation were applied. Due to the progression of respiratory failure, she was intubated and sedated with midazolam-remifentanyl infusion. Sedation was terminated 48 hours later. No extremity movement was observed after the sedation was terminated. No pathology was detected in the brain CT except for chronic ischemic changes and atrophy. The diagnosis of GBS was excluded because CSF analysis was normal and motor dysfunction findings were prominent in EMG. The diagnosis of CIPM was made with EMG. Extremity movements of the patient started with appropriate treatments and physical therapy exercises. She was transferred to the palliative care unit as GCS: 13 with tracheostomy accompanied by a home ventilator. Discussion: Neuromuscular weakness in intensive care patients is usually considered when patients cannot get rid of mechanical ventilator support, and the onset of diagnosis is usually unknown. Main clinical features; distal predominantly muscle weakness, hyporeflexia/areflexia, and muscle atrophy. The diagnosis of this disease was made by EMG. The duration of stay in mechanical ventilation, ICU and hospital stay is prolonged in patients who develop CIPM. So the quality of life of patients reduces and the cost of treatment and care increases. Awareness should be raised in ICUs, especially in critically ill patients who are dependent on mechanical ventilators, administered sedation, neuromuscular blockers, and steroids. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to present a case of tracheal bronchus, which was diagnosed incidentally under fiberoptic bronchoscopy in our intensive care patient who underwent bedside elective tracheostomy, in the light of literature. Case: A 72-year-old male patient who underwent decompressive craniectomy operation due to acute subdural hematoma after a simple fall in the service follow-up of our University of Health Sciences Turkey, İstanbul Fatih Sultan Mehmet Health Training and Research Center Hospital in February 2023 was admitted to our intensive care unit for postoperative intensive care follow-up. In the follow-ups, the patient whose Glasgow Coma score was below 8 and was followed-up with orotracheal intubatedmechanical ventilator support; Bedside percutaneous tracheostomy was performed with fiberoptic bronchoscopy on the 9th day of intensive care unit follow-ups. In fiberoptic bronchoscopy, there was an accessory bronchus approximately 2.5-3 cm above the carina, directly separating from the right wall of the trachea and extending towards the right upper lobe parenchyma. Discussion: Tracheal bronchus is a rare congenital anomaly defined as an abnormal bronchus originating from anywhere from the cricoid cartilage to the carina. It was first described by Sandifort in 1785 as the right upper lobe bronchus originating from the trachea. Although patients are often asymptomatic and incidentally detected; it may cause clinical findings in a spectrum ranging from recurrent lung infections, purulent secretion, stridor, and foreign body aspiration. In diagnosis, X-ray, computed tomography, bronchoscopy, MR imaging allow tracheobronchial tree to be visualized. Virtual bronchoscopy with computed tomography is a new method used in the imaging of the tracheobronchial tree in recent years thorax computed tomography image [ABSTRACT FROM AUTHOR]

Introduction: Esophageal perforation is a rare potentially life-threatening event. Early clinical suspicion and treatment is important for case management to achieve a good outcome. In this case, we aimed to describe the treatment plan of a patient in the intensive care unit who had esophageal perforation due to chicken bone aspiration. Case: A 48-year-old male patient with no comorbidities was admitted to the emergency department with complaints of pain and burning in the throat that started after eating chicken. Physical examination revealed swelling and fever in the left parotid gland region. Perforation in the upper esophagus was detected in the thorax CT (Figure 1). Tissue cultures were taken from the perforated area and pleura. Empirical meropenem 3x2 gr, vancomycin 2x1 gr and anidulafungin 1x100 mg was started. On the 8th day of the post-op follow-up, when purulent content came from the thoracic drain, leakage was detected with oral methylene blue test. The patient was re-operated, and esophagostomy and tube jejunostomy were done. Polymyxin B 2x120 mg was added to the treatment because of the acinetobacter baumani growth in the tissue and blood culture. Nutritional support was provided with parenteral way. The need for vasopressors decreased with antibiotics, appropriate fluid and other conventional treatments. He was extubated and then discharged to the service on the 24th day of hospitalization. Discussion: Management of esophageal perforations and subsequent major complications requires a multidisciplinary approach. Mortality can decrease with early diagnosis, appropriate surgery according to the clinical situation and effective treatment approaches in intensive care units. Our patient was discharged to the ward with early focal control and effective treatment with appropriate fluid-vasopressor and antibiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Our aim is to determine the brain damage caused by COVID-19 by examining the brain tomographies and predictive feature by examining the laboratory data at 0. and 7. days. Materials and Methods: A total of 60 patients, 30 with COVID-19 and 30 with non-COVID-19, were analyzed and patient data were compared. Brain tomography reports taken within the first 72 hours were analyzed. Age, gender, comorbidities, ICU stay, mortality, hemogram, total biochemistry and coagulation parameters were analyzed. Statistical significance level was accepted as p<0.05. Results: Mortality rates and the hospitalization days were higher in the COVID-19 group. Intracranial hemorrhages (ICH) rates were higher in both groups compared to ischemia. ICH was detected in 21 (70%) and cerebral infarction in 9 (30%) patients of COVID-19 patients. Right hemisphere and frontal lobe was the most common in the intracranial hemorrhage region and intraparenchymal hemorrhage (90%) was the most common in the type of hemorrhage. Shifts were found in 42% of the patients. In patients non-COVID-19, 22 (73.3%) patients had hemorrhage and 8 (26.7%) patients had infarction. Left hemisphere and frontal lobe was the most common in the intracranial hemorrhage and intraparenchymal hemorrhage (90%) was the most common in the type of hemorrhage. 31.8% of the patients had shifts. 22% of the patients had cerebral infarct. In COVID-19 patients 77% had right and 33% left hemisphere infarcts. Infarcts were observed in the right hemisphere in 75% of non-COVID-19 patients and in the left hemisphere in 25%. D-dimer, PLT, neutrophils, AST, ALT, BUN, and urea were found to be statistically significantly higher in the COVID-19 patientS. PaO2 /FiO2 ratios were found to be statistically significantly lower in the COVID-19 patient group. Hospitalization and 28-day mortality rates of the groups (%). Conclusion: We concluded that while the pathogenicity of COVID-19 and preventive treatment approaches affect neurological complications, ischemic or hemorrhagic type proportionally changes and has a bad effect on prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Drug-induced nephrotoxicity, continues to be one of the leading causes of acute renal failure in hospitalized patients. In this case report, we present a patient who consumed olive oil for three days due to constipation, which led to the induction of acute renal failure. Case: An 81-year-old man with a history of coronary artery disease and heart failure presented to the emergency department complaining of constipation that had lasted three to four days during the initial evaluation, the patient was found to have a serum urea level of 532 mg/ dL, a serum creatinine level of 20 mg/dL, and profound metabolic acidosis, a preliminary diagnosis of acute renal failure was made, and the patient was promptly admitted to the medical intensive care unit. the patient reported having ingested olive oil several times previously without any associated adverse effects. The patient underwent hemodialysis. Following this procedure, laboratory values revealed a urea level of 428 mg/dL and a reduction of the creatinine level to 15 mg/dL. Subsequently, the patient demonstrated spontaneous urine output and did not require any further dialysis sessions. The patient was transferred to the nephrology wards with a creatinine level of 0.93 mg/dL. Discussion: Acute renal failure is relatively common in intensive care units, the etiology of acute renal failure is multifactorial in most cases, several recent large epidemiological studies have shown that nephrotoxic drugs cause 19-25% of severe acute renal failure. Herbal drug-induced nephrotoxicity continues to be prevalent cause of acute renal failure among hospitalized patients. Although olive oil possesses nephroprotective properties such as anti-oxidant, anti-inflammatory, and anti-apoptotic activity it has demonstrated a paradoxical effect on our patient. This may be due to the patient’s repeated ingestion of olive oil at one time or the cumulative dose of over a period of time. We believe that this case is interesting and warrants further investigation [ABSTRACT FROM AUTHOR]

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome that can also occur during pregnancy. Although many underlying pathological mechanisms have been proposed, the vasogenic theory is the most postulated theory and leads to hypertension and detoriation of the cerebral autoregulation. PRES patients usually present with hypertension and neurological symptoms including headache, mental deterioration, vision changes, cortical blindness, nausea, vomiting, and epileptic seizures. Diagnosis can be made by neurological examination, and radiologic imaging. With early diagnosis and appropriate treatment, most patients recover without sequelae. Although rare, patients may require intensive care management, and also disease may cause death if not diagnosed and treated early. This presentation will describe a 23-yearold pregnant woman who was admitted to the emergency with seizure. Case: A 23-year-old pregnant woman was admitted to the emergency with seizures. Her blood pressure was 200/100 mmHg and her Glasgow coma scale was 10 on admission. She was immediately taken to a cesarean section as her prediagnosis was eclampsia. She revealed a diplopia and blurred vision that began 3 days before the admission. Following cesarean section, cranial magnetic resonance imaging showed parietooccipital leukoencephalopathy and she was diagnosed as PRES. Following 4 weeks of follow-up in the intensive care unit patient was discharged with minimal neurological sequela. Discussion: In a pregnant woman, seizure(s) generally direct the physicians to a diagnosis of eclampsia. Evaluation of the neurological symptoms in all aspects may provide the early diagnosis of PRES. Early diagnosis and appropriate treatment in such patients ensure better neurological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen therapy (HBOT) is effective as an adjunctive therapy in the treatment of crush injuries. Case: A 29-year-old female earthquake survivor who has been rescued from the debris at the 24th hour, was referred to our center with crush injury at the right upper extremity. Fasciotomy was performed due to the compartment syndrome on the right hand and arm at the health institution where the patient was first taken. As a consequence of elevated creatine kinase, oliguria, obesity and need for supplemental oxygen therapy; the patient admitted to intensive care unit (ICU). Laboratory parameters of the patient on admission and discharge are shown in Table 1. The patient treated with normal saline solution, antibiotics, and intravenous analgesics. On our first sensory examination, all fingers of the right hand were hypoesthetic; and on the motor examination, limitation of flexion and extension was noted in all fingers of the hand. Refill in all fingers of the right hand was evaluated as indeterminate. Wound assessment was made by orthopedists and plastic surgeons, stated that amputation may be required eventually. As soon as hemodynamic stabilization was achieved, the patient’s HBOT sessions were planned. The patient underwent 11 times 120 minutes of HBOT with oxygen at 2.5 atmospheres absolute (ATA) while breathing 100% oxygen. The patient underwent debridement at the 8th, 15th and 22th day of follow-up. On the post-operative examination after the third operation, it was seen that all finger refills on the right hand were sufficient (Figure 1). Through appropriate treatment; creatine kinase level decreased, urine output improved so the patient was discharged from ICU. Discussion: The multidisciplinary approach with HBOT, antibiotics and debridements may result in the salvage of the limb at the patients presenting with crush syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Myasthenia gravis (MG) is an autoimmune neuromuscular disease that affects the post-synaptic acetylcholine receptors, which often occurs with involvement of the periocular muscles. In atypical forms that do not progress with ptosis, the diagnosis may be delayed or misdiagnosed. In this case report, we present an atypical MG patient who presented with dyspnea. Case: A 40-years-old female patient who applied to different clinics with the complaints of dyspnea intermittently for 10 years. Patient was admitted to the emergency service with respiratory distress without ptosis and muscle weakness in her extremities. Her arterial blood gas (pH: 7.15, pCO2 : 147, pO2 : 123, HCO3 : 23) was evaluated as severe respiratory acidosis in the emergency department and was admitted to our ICU after endotracheal intubation. The patients’ respiratory support needs resumed. Four unsuccessful weaning attempts occured during the intensive care follow-up of the patient. During the extubated period, laryngeal endoscopy was performed by ENT clinic. Vocal cord pathology was not detected. She was not tolareted extubation therefore she was re-entubated. During follow up of the patient who did not benefit from the pyridostigmine treatment with the prediagnosis of MG, ach receptor antibody result seen negative and anti-MuSK antibody result seen positive. EMG was not reported as compatible with MG. Due to clinical suspicion, the patient was treated with intravenous immunoglobulin (IVIG) with the recommendation of neurology, and tracheostomy was performed due to prolonged intubation. The patient, whose dyspnea symptoms regressed after IVIG treatment able to provide spontaneous breathing with tracheostomy and was transferred from ICU to neurology service. Discussion: Kanemaru et al. in his atypical MG case which localized to the larynx, diagnosed with edrophonium test. We believe that atypical forms of MG can be considered in the differential diagnosis of severe hypercarbic conditions with type 2 severe respiratory failure of unknown etiology. As in our case who did not benefit from pyridostigmine, anti-MuSK antibody recommended to see. [ABSTRACT FROM AUTHOR]

Introduction: The number of elderly patients taken to intensive care unit (ICU) is gradually increasing due to the prolongation of life expectancy. According to UK data, the majority of newly diagnosed cancer patients are people over the age of 65, and the highest incidence of cancer is in people between the ages of 85 and 89. The aim of our study is to reveal the ICU outcomes, mortality in oncological patients over 65 years of age, and to document the predisposing factors that cause mortality. Materials and Methods: After the ethics committee approval was obtained, the data of oncology patients over the age of 65 who were treated in ICU between 01/01/2020 and 12/31/2021 were retrospectively analyzed. Results: Of the total 706 patients treated in ICU, 174 were oncology patients over the age of 65. There were 98 people in the 65-74 age range and 76 people over the age of 75. Although patients over 75 years of age had higher APACHE II scores, hospital and ICU mortality rates were similar to those of the other age group. Among the factors affecting ICU and hospital mortality, it was significant that patients used vasoactive drugs at any time and needed invasive mechanical ventilation support. Hospital mortality was found to be lower in cancer patients who underwent surgery in the last 6 months than in patients who did not undergo surgery. Conclusion: Mortality is quite high in ICU treatment of elderly critically ill patients with cancer. In this retrospective study, it was seen that the mortality rate of oncological patients over 65 years of age who were treated in ICU was over 70%. It was found that the mortality risk was more than 2 times higher in patients requiring invasive mechanical ventilation and vasoactive drugs. There was no difference in mortality between solid and hematological cancers. [ABSTRACT FROM AUTHOR]

Introduction: Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by developmental retardation, mental disability, obesity, shot stature, hypogonadism anddysmorphic findings. Patients with the syndrome exhibit abnormal ventilation responses to hypoxia and hypercapnia, and these can be exacerbated with obesity. Case: A 17-year-old male patient diagnosed with PWS was admitted to the intensive care unit due to acute respiratory insufficiency. His PaO2 / FiO2 value was 170, his respiration rate was 40/min, and he was dyspneic. He also had a history of admission to the neonatal intensive care unit. At physical examination he weighed 180 kg, was 170 cm in height, with a body mass index of 62.2 kg/m2, body temperature 36.9 ºC, respiration rate 40/min, oxygen saturation 89%, heart rate 125 beats/min, and blood pressure 126/60 mmHg. On arrival the patient was hypoxic, hypercapnic, tachypneic and dyspneic and respiratory exercises with CPAP and a highflow nasal cannula were applied for treatment. The respiratory difficulty improved during follow-up. FiO2 and flow were reduced by means of arterial blood gas monitoring. No respiratory difficulty was observed at nasal cannula follow-up, and the patient was transferred to the ward on the seventh day of admission to intensive care. Discussion: These patients require an obesity bed in intensive care, a blood pressure cuff, and appropriate medical equipment. Alveolar hypoventilation during sleep may occur in PWS in association with an increasing burden on partially weak respiratory muscles. Morbid obesity is linked to desaturation during sleep in children without other medical conditions. The extra burden on the respiratory muscles caused by obesity is heightened by muscular inhibition occurring during REM sleep, when hypoventilation may develop. The intubation and ventilation of these patients may be problematic. This patient with a manifestation of moderate ARDS was successfully followed up with high-flow and noninvasive mechanical ventilation and subsequently discharged to the ward. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have reported that right pneumonectomy is associated with worse perioperative mortality compared to left pneumonectomy. We aimed to compare the demographic characteristics, intensive care follow-up and in-hospital/30-day/90-day mortality rates of right and left pneumonectomy patients admitted to the intensive care unit (ICU) in the early postoperative period. Materials and Methods: Medical records of all patients routinely admitted to ICU after pneumonectomy between January 7, 2010 and December 31, 2022 were retrospectively analyzed. Results: During the study period, 79 out of 84 patients who underwent pneumonectomy were included. Seventy one patients (89.9%) were male and the mean age was 59.7±11.2 years old. All patients had ASA score 2 and above. Right pneumonectomy was performed in 33 patients (41.8%) and left pneumonectomy in 46 patients (58.2%). APACHE-II scores at ICU admission were significantly higher among right pneumonectomy patients when compared to those with left pneumonectomy (10.4±6.8 vs 7.3±4.2, p=0.024). All patients with right pneumonectomy had PaO2 / FiO2 ratio <400 and invasive mechanical ventilation was required among 12% of them. In-hospital mortality (27.3% vs. 6.5%, p=0.023), 30-day mortality (21.2% vs. 4.3%, p=0.03), 90-day mortality (24.2% vs. 6.5%, p=0.045) were significantly higher in patients with right pneumonectomy when compared to those with left pneumonectomy. According to the logistic regression analysis; right pneumonectomy was determined as an independent risk factor for in-hospital/30-day/90-day mortality (OR: 5.375, 95% CI 1.327-21.771, p=0.018/OR: 5.923, 95% CI 1.144-30.674, p=0.03/OR: 4.587, 95% CI 1.114-18.891, p=0.04). Conclusion: Early postoperative outcomes of right pneumonectomy patients admitted to ICU revealed higher APACHE-II scores, requirements for invasive mechanical ventilation when compared to left pneumonectomy patients. Right pneumonectomy was associated with higher mortality. [ABSTRACT FROM AUTHOR]

Introduction: This article aims to measure the prevalance of venous thromboembolism, predict it with the data provided by clinical findings and test results of COVID-19 patients followed up in ICU, and determine the dose of anticoagulan agents. Materials and Methods: Patients divided into two groups; n=53 who developed VTE, n=54 who did not develop thromboembolic events between April 1, 2020 and July 31, 2021. Patients who developed thromboembolism were divided into groups by imaging methods used for diagnosis of thromboembolic events (pulmonary embolism, deep vein thrombosis, and acute infarction). Wells score was measured based on patient epicrisis. D-dimer, fibrinogen, Interleukin-6, ferritin, platelet count, activated partial thromboplastin time (aPTT), lactate dehydrogenase, C-reactive protein, Troponin-I measures. Results: Mean age of the individuals is 63.6±15.3. Of the patients, 20.6% had pulmonary embolism, 9.3% had DVT, and 19.6% had acute infarction. As a result of the statistical analysis, the mean age and mortality rate of patients who developed VTE are found to be higher. In addition, Of those who developed VTE; D-dimer levels at day 2, week 1, and troponin levels at week 1 and discharge are found to be considerably higher. And also fibrinogen levels at Admission, day 2, day 3, PLT levels at day 2, day 3, week 1, There was no difference between the groups in terms of length of stay in ICU and duration of mechanical ventilation. Conclusion: It should always be considered that there may develop VTE in critically-ill COVID-19 patients following up in the ICU. It is widely known that COVID-19 causes a tendency to clot and the mortality of patients who develop thromboembolism is high. Despite this, since the patients are not stable, it can be challenging to diagnose thromboembolism with various imaging methods in ICU patients. For this reason, it is important to predict thromboembolism with clinical findings and blood test results. [ABSTRACT FROM AUTHOR]

Introduction: The STOP-BANG survey has a sensitivity of 88-92% in detecting OSAS, above 3 points. Postoperative complications are more common in patients with OSAS. The aim of this study is to investigate the relationship between the STOP-BANG score and postoperative pulmonary complications. Materials and Methods: From January 2nd to January 13th, 2023, voluntary patients who were scheduled for elective surgery under general anesthesia were included in the study. After the operation, vital signs, saturation, and medical imaging of the patients were examined. Hypoxia with or without atelectasis, pneumonia, and the need for non-invasive or invasive mechanical ventilation were considered pulmonary complications. Patients who had a saturation value of less than 92% for more than 2 hours in room air with nasal or mask oxygen requirement were considered hypoxic. According to the STOP-BANG survey, patients were divided into two groups, below or above 3 points. Pulmonary complications in both groups were statistically analyzed using the chi-square test. Results: A total of 159 patients were included in the study, of whom 66 were male and 93 were female. According to the STOP-BANG score, 77 patients had scores above 3, and 82 patients had scores below 3. The average age of the patients was 54.4. 8.8% of the cases (14/159) underwent major surgery. The average ASA score was 2.05, and the average Mallampati score was 2.11. According to the STOP-BANG score, 7 patients (7/82) in the group below 3 points and 17 patients in the group 3 points and above (17/77) were pulmonary complicated. The p-value was 0.031, indicating a statistically significant difference between the two groups. Pulmonary complications were observed in 8 of 14 patients admitted to the intensive care unit. Conclusion: Due to its high sensitivity for scores above 3, the STOPBANG survey can be used as an alternative cost-effective tool to predict postoperative pulmonary complications. [ABSTRACT FROM AUTHOR]

Introduction: Our aim is to measure the level of knowledge of intensive care nurses about delirium, determine the change in the level of expertise with the training given after ward, andi investigate the effect of the difference in the level of knowledge on practice. Materials and Methods: Forty-three nurses working as nurses in intensive care units (ICU) and volunteering to participate in this study were included in the study. Thirty-six patients followed in the intensive care Unit were evaluated for delirium. Delirium education has been prepared according to the Padis Guide (2018). The knowledge level and practical evaluation tests were administered to the ICU nurses both before and after the training. Theoretical test: The delirium knowledge test for the intensive care nurse (DKT-ICN) (Figure 1), defined in a previous study, was used as the delirium knowledge level test. Practical test: Patients were evaluated with/without delirium with the CAM-ICU scale. Results: The median age of the nurses was 27 (min-max: 23-45), 29 (67.4%) of them were female, and 14 (32.6%) were male. Education levels were 12 (27.9%) Associate degrees and 31 (72.1%) under graduate degrees. The number of nurses who had previously received delirium training was 13 (30.2%), and the number of those who did not was 30 (69.8%) In the test evaluations of the nurses before and after the training, the accuracy rate of the DKT-ICN test before training was 75.19%, while the post-training accuracy rate increased to 92.76%, and there was a statistically significant difference (p<0.01). In the practical test, the accuracy rate was 68.47% before the training and increased to 74.16% after the training, but there was nostatistically significant difference (p=0.15) (Figure 2). Conclusion: As a result, the knowledge level of nurses about delirium is significant for the prognosis of delirium. Although standard training increases theoretical knowledge, more is needed to diagnose in practice. Different training models may be required to be effective in clinical practice. Scientific studies are needed on this subject. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the risk of death of patients with a diagnosis of COVID-19 followed in the intensive care unit according to age, gender, vaccine type and vaccine dose status. Materials and Methods: The present study was planned by retrospectively evaluating the data of patients admitted to the intensive care unit between March 2021 and August 2022 with the diagnosis of COVID-19. The patients were evaluated in 6 groups according to their vaccination status. Groups were 0: not vaccinated, 1: One or two doses of Sinovac, 2: Three doses of Sinovac, 3: One dose of BioNTech, 4: Two doses of BioNTech. Results: Three hundred fifty-one patients were included in the study. The mean age of the patients was 67.1±15.6 and 191 (54.4%) patients were male. Two hundred fourteen (61.0%) of the patients were unvaccinated. The unvaccinated group had the highest mortality rate (86.4%). Two doses of BionTech vaccine had statistically lower mortality rates than the other groups (p<0.005). The relationship between age groups and mortality was statistically significant (p=0.014). The group over 75 years old had statistically significant higher mortality rates compared to the other groups. Age and vaccination status were found to be effective on mortality in multivariate analysis. The group over 75 years of age had a higher risk of mortality compared to the other groups (p=0.002). Patients with 2 doses of BioNTech vaccine showed a lower mortality rate in multivariate analysis compared to unvaccinated patients (p=0.001). The other vaccine groups did not have a protective effect against death. Conclusion: SARS-CoV-2 is a disease with high mortality rates and these rates are being reduced by vaccination studies. Patients over the age of 75 face higher mortality rates. The full-dose BionTech vaccine significantly reduces mortality rates. Single-dose BionTech or full-dose Sinovac vaccines appear to be insufficient to prevent mortality [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a common dysfunction in critically ill patients admitted to intensive care unit (ICU), and the assessment of nutrition in the ICU poses a unique challenge for clinicians. The aim of our study is to investigate the performance of nutritional screening tools in predicting hospital, 28-day and 3-month mortality in critically ill patients admitted to the ICU due to respiratory failure (RF). In this report; we aimed to share the 1-month preliminary results of our study and the 28-day mortality data with you. Materials and Methods: To the first 1-month preliminary report of our prospective observational study; all adult patients (≥18 years old) who applied to the ICUs with RF and stayed in the ICU for more than 72 hours were included, with the decision of the ethics committee numbered 2012- KAEK-15/2627. Multiple logistic regression analysis and relative risk for mortality prediction performance of the instruments were used to test the complementarity between mNUTRIC and NRS-2002. Results: One hundred twenty patients were evaluated. The outcomes of the patients according to 1-month mortality are given in Table 1. In patients included in the study, 50% (p=0.453) by NRS-2002, 71.7% (p<0.001) by mNUTRIC, and 40.8% (p=0.046) by mNUTRIC + NRS-2002 (score ≥5) were found to be at high nutritional risk. The risk of 28-day mortality was 8.5 times higher in patients with mNUTRIC ≥5, one times in patients with NRS-2002 ≥5, and 1.5 times more in patients with mNUTRIC + NRS-2002 ≥5 (Table 2). mNUTRIC AUC 0.782; NRS-2002 AUC 0.521 and mNUTRIC + NRS-2002 AUC 0.636 were detected (Figure 1). Conclusion: There is no specific study in the literature on nutritional risk screening of critically ill patients with RF. It is not known whether the sensitivity of these scores changes according to the type of RF. The mNUTRIC score is statistically superior to the use of NRS-2002 and the combined two scores in predicting 28-day mortality in patients admitted to the ICU with RF. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to compare respiratory muscle functions and strength evaluated by ultrasonography between patients who successfully weaned and those who failed to wean. Materials and Methods: This study was conducted in the Respiratory Intensive Care Unit (RICU) of a University Hospital. Between September 2021 and December 2022. Demographic data, disease severity scores and respiratory muscle functions and thickness measured by ultrasonography [diaphragm thickness (DT), diaphragm excursion (DE), diaphragm thickening fraction (DTF), expiratory abdominal muscle thickness, peak contraction velocity (PCV) and peak relaxation velocity (PRV) of diaphragm detected by tissue doppler imaging] were recorded. In addition, respiratory muscle strength, peripheral muscle strength and physical functions were evaluated by maximum inspiratory pressure (MIP) measurement, medical research council (MRC) and physical function scale for intensive care (PFIT) scores. Results: The mean age of the study population was 66.73 (min-max: 28- 88) years. Seven female and 19 male were included the study. Twenty patients (77%) were successfully weaned. The MIP (35.0 vs 14.0; p=0.02), MRC (49.4 vs 35.0; p=0.02), PFIT (4.40 vs 2.17; p=0.02), DE (4.11 vs 2.6; p=0.010) and rectus abdominus thickness (0.85 cm vs 0.53 cm; p=0.011) measurements were higher in patients with successful weaning than patients with weaning failure. As expected, duration of stay in ICU (7.45 vs 21.0; p=0.00) and in hospital (12.0 vs 21.0; p=0.01) were shorter in succesfully weaned patients. There was no significant difference between APACHE-II scores (26.9 vs 29.0; p=0.97), DT-inspiration (0.29 cm vs 0.28 cm; p=0.85), DT-expiration (0.23 cm vs 0.21 cm p=0.92), DTF (27.0% vs 30%; p=0.58), PCV (10.07 cm/sn vs 8.80 cm/sn; p=0.30), PRV (11.40 cm/ sn vs 10.11 cm/sn; p=0.60), thickness of the internal oblique (0.53 cm vs 0.43cm; p=0.27), external oblique (0.41 vs 0.37; p=0.52), transversus abdominus (0.36 cm vs 0.38 cm; p=0.33) muscles. Conclusion: Our study results show that lower diaphragm excursion, MIP, rectus abdominus muscle thickness, and physical function scores are associated with poor clinical outcome and weaning failure. We believe that ultrasonographic asessment of respiratory muscles in the RICU can provide a different perspective in the weaning process [ABSTRACT FROM AUTHOR]

Objective: Since the COVID-19 pandemic caused respiratory failure in many patients, oxygen delivery methods had to be diversified, and their numbers increased. High flow nasal cannula (HFNC), which has been shown beneficial in acute respiratory failure previously, also came to the fore. We aimed to investigate the efficacy of HFNC on patients hospitalized in intensive care units due to COVID-19. Materials and Methods: We retrospectively screened the patients followed in the intensive care unit due to COVID-19. Patients treated with HFNC performed the study group. We analyzed the relationship between demographics, laboratory results, treatment modalities, complications, and outcomes. Results: Among the 330 patients included mean ventilation duration with HFNC was 7.84 days. 170 (51.5%) patients intubated during HFNC treatment. Only 5 of them were extubated. Intubated patients had higher mean HFNC duration (9.74 days - min: 2, max: 49) compared to nonintubated patients (6.05 days - min: 1, max: 30). There was a significant relationship between mortality and age (OR: 1.04), APACHE II score (OR: 1.35), having cancer (OR: 3.89), receiving NIV (OR: 5.94), and presence of secondary bacterial infection (OR: 44.6). Conclusion: HFNC, whose benefit in acute respiratory failure has been proven, is also widely and successfully used in COVID-19 patients. Comprehensive randomized studies are needed to demonstrate the effect of HFNC use on intubation requirement and mortality. [ABSTRACT FROM AUTHOR]

Objective: Invasive pulmonary aspergillosis is a complication of respiratory bacterial and viral infections such as COVID-19. Materials and Methods: In our hospital, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) PCR positive and Aspergillus spp. We analyzed the clinical and demographic characteristics of 13 patients with. Results: Aspergillus species were identified in 13 patients aged between 54 and 85 (mean 73.46±9.11). Of 13 patients, 8 were male and 5 were female. All patients were intubated. The mean time between SARS-CoV-2 PCR positivity and intensive care admission. 5.69±5.8 days, hospitalization period before intensive care unit 3.62±3.7 days, intensive care unit stay of the patients 12.69±9.87 days, time between intubation and tracheal aspirate culture 4.46±4, it was 66 days. Five patients needed renal replacement therapy. The most common comorbidity observed in the patients was diabetes mellitus. The mean time between culture and death was 7.23±7.60 days. Aspergillus spp. growth was observed in control cultures of 5 patients. Aspergillus fumigatus grew in 9 patients, Aspergillus flavus in 2 patients, and Aspergillus niger in 2 patients. While 12 patients died, 1 patient survived. Conclusion: COVID-19-associated pulmonary aspergillosis (CAPA) is a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following SARS-CoV-2 infection, with incidence rates ranging from 8 to 33%. However, the definitive diagnosis of CAPA is difficult. Standard diagnostic algorithms and definitions are missing. The most complex problem in ARDS patients is to differentiate Aspergillus colonization from invasive disease. Bronchoalveolar lavage is generally avoided because of the aerosolization of the virus and the high risk of transmission to healthcare providers during the procedure.As radiological findings may overlap between COVID-19 ARDS and invasive pulmonary aspergillosis, it is extremely important to seek microbiological diagnosis to minimize mortality and morbidity due to coinfection. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 disease is unfortunately not yet understood and a definitive treatment has not been found. The aim of this study is to investigate the changes in clinical and laboratory tests of critical COVID- 19 patients followed in the intensive care unit between March/2020 and December/2020 and to evaluate the factors that cause these changes with literature information. Materials and Methods: In the study, during the beginning of the pandemic and its progress; 50 COVID-19 patients treated in the intensive care unit (ICU) between March-April-May/2020 were defined as group 1, and 50 COVID-19 patients treated in the ICU between October-November- December/2020 were defined as group 2. Clinical, laboratory and intensive care processes of the patients in the groups were analyzed retrospectively and compared. Results: Age and gender distribution in terms of demographic data was similar between group 1 and group 2. APACHE-II score average of group 1 was 22, and APACHE-II score average of group 2 was 25. There was no statistically significant difference between the demographic data of the groups (Table 1). As a result of statistical analysis, while there was no significant difference between the groups in terms of CRP and ferritin values, there was a significant difference between the D-dimer values. The values of the patients in group 1 were found to be higher than in group 2 (Table 2). Group 2 patients had higher 28-day mortality, and this result was statistically significant (p=0.006). Transfer rates of group1 patients to the service after intensive care were found to be statistically higher (p=0.029) (Table 3). Conclusion: As a result of this study, 28-day mortality was found to be different between similar patient groups who were admitted to intensive care during different periods of the pandemic.The reasons for this may be: changes in pathogenicity as a result of viral mutations, different immune responses of hosts to viral infection. Another factor influencing this outcome may be the presence of less experienced healthcare professionals in critically ill care. [ABSTRACT FROM AUTHOR]

Objective: Some of the intensive care patients are at the terminal stage of their chronic diseases. In such cases treatment is controversial. In our country, some of the patients in the terminal stage of their chronic disease are followed up in the intensive care unit. It is recommended that these patients should be followed up in palliative care units instead of intensive care units. The integration of practices such as end-of-life decisions to the health system was seen as an indicator of a country’s level of development. The number of palliative care units in our country is not enough but increasing by the time. The literature was reviewed in the light of this information, it was seen that the number of studies evaluating the knowledge and attitudes of nurses and physicians about end-of-life decisions, who will take part in the decision process, is limited. In this study, it was aimed to increase awareness about end-of-life decisions and evaluate the knowledge level of physicians and nurses who would take part in this process Materials and Methods: The study planned as a nationwide, multicenter, cross-sectional, descriptive questionnaire study. Between August 2018 and August 2019, 259 of 760 intensive care physicians and nurses who filled out the study questionnaire sent by e-mail and multimedia message were included in the study. Study participation was voluntary. Responses were anonymous and non-traceable to individual participants. The questionnaire included the demographic characteristics of nurses and physicians and the duration of experience in intensive care, the unit and the institution that participitants work in, as well as definitions and questions about end-of-life decisions. Results: Two hundred and fifty-nine participants were included, 73 (28.2%) of the participants were male, 186 (71.8%) were female; the average age was 34±8 years; there were 119 intensive care physicians (45.9%) and 140 (54.1%) intensive care nurses. It was observed that the knowledge level of the participants was insufficient (46%, 58%) about the concepts of withholding and withdrawal. In other questions, the rate of those who stated that they knew the concepts was between 88-98%.It was observed that the rate of terminal sedation and euthanasia decision decreased with a statistically significance between the groups as the participants’ experience in the intensive care increases. When asked who should make the end-of-life decision; intensive care physician 89.6% (n=232) and 56.8% (n=147) patients in the terminal stage of chronic disease were the most common responses (Table 1, 2, 3). Conclusion: In this study, in which the knowledge levels and attitude of intensive care unit physicians and nurses about end-of-life decisions were evaluated, it is considered that there is a need for increase the knowledge level of intensive care workers, and also for standardization physicians’ and nurses’ attitude about end-of-life decision making process. [ABSTRACT FROM AUTHOR]